Provider Demographics
NPI:1811960636
Name:DEUTSCH, MARILYN WEISBERG (PHD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:WEISBERG
Last Name:DEUTSCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WYNDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:PA
Mailing Address - Zip Code:18414-9546
Mailing Address - Country:US
Mailing Address - Phone:570-563-2557
Mailing Address - Fax:570-563-1325
Practice Address - Street 1:111 WYNDWOOD RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:PA
Practice Address - Zip Code:18414-9546
Practice Address - Country:US
Practice Address - Phone:570-563-2557
Practice Address - Fax:570-563-1325
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003709L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA221987Other1ST PRIORITY POS
PADE042473OtherBLUE CROSS/BLUE SHIELD
PADE042473OtherBLUE CROSS/BLUE SHIELD